Impulsive and compulsive behaviors in Parkinson's disease

Abstract

Background: Impulsive and compulsive behaviors (ICBs) are a heterogeneous group of conditions that may be caused by long-term dopaminergic replacement therapy (DRT) of Parkinson's disease (PD). The spectrum of ICBs includes dopamine dysregulation syndrome (DDS), punding and impulsive control disorders (ICDs). Contents: We made a detailed review regarding the epidemiology, pathology, clinical characteristics, risk factors, diagnosis as well as treatment of ICBs. Results: The prevalence of ICBs in PD patients is approximately 3-4% for DDS, 0.34-4.2% for punding and 6-14% for ICDs, with higher prevalence in Western populations than in Asian. Those who take high dose of Levodopa are more prone to have DDS, whereas ICDs are markedly associated with dopamine agonists (DAs). Different subtypes of ICBs share many risk factors such as male gender, higher Levodopa equivalent daily dose (LEDD), younger age at PD onset, history of alcoholism, impulsive or novelty-seeking personality. The Questionnaire for Impulsive-Compulsive Disorder in Parkinson's Disease-Rating Scale (QUIP-RS) seems to be a rather efficacious instrument to obtain relevant information from patients and caregivers. Treatment of ICBs is still a great challenge for clinicians. Readjustment of DRT remains the primary method. Atypical antipsychotics, antidepressants, amantadine, and psychosocial interventions are also prescribed in controlling episodes of psychosis caused by compulsive DRT, but attention should be drawn to balance ICBs symptoms and motor disorders. Moreover, deep brain stimulation of the subthalamic nucleus (STN-DBS) might be a potential method in controlling ICBs. Conclusions: The exact pathophysiological mechanisms of ICBs in PD remains poorly understood. Further researches are needed not only to study the pathogenesis, prevalence, features and risk factors of ICBs, but to find efficacious therapy for patients with these devastating consequences.